Small volume hyperosmolar abdominal CT in acute small bowel obstruction

Abstract

Purpose: Identification of the degree of small bowel obstruction (SBO) is helpful in patient management decisions since the treatment of partial SBO is nonoperative, whereas the treatment of complete SBO requires surgical intervention. We describe a technique providing the benefits of CT and enteroclysis together, which allows the radiologist to determine the degree of the SBO and thereby to distinguish partial from complete SBO. Methods and materials: Abdominal CT scans were performed on 21 patients. Patients were given 200 ml concentrated oral contrast medium. Serial radiographs followed the progression of contrast at 1, 3, and 5 h in order to optimize the timing of the abdominal CT. A partial SBO was diagnosed if the oral contrast reached the colon at or before the 5-h film, and a complete SBO if the oral contrast did not reach the colon by the 5-h abdominal radiograph. The CT was performed when the contrast reached the colon or after the 5-h film. Results: CT findings demonstrated complete obstruction in eight patients, all of whom required surgical treatment. Partial SBO was demonstrated in 13 patients. Ten of the 13 patients with partial SBO had an uncomplicated transition zone, probably due to adhesions, and were treated medically. Nine of these patients were managed with nasogastric tube decompression and were discharged without surgical intervention. One patient failed to respond to a 12-h course of nasogastric tube decompression and underwent lysis of adhesions. Three of the 13 patients had a complicated transition zone, due to an intussusception and two hernias, which were responsible for the SBO. Two were treated surgically and one medically. Conclusion: The use of small-volume hyperosmolar abdominal CT allows the radiologist to determine the degree of the SBO. This additional information is very useful in patient management because uncomplicated partial SBO is often treated successfully via tube decompression, whereas complete SBO requires surgical intervention.